One of the first things that I found as a psychologist who specializes in working with anxiety clients was that they focused on the most negative moments in their lives and obsessed about them.  I don't in any way mean this in a judgmental fashion because I have been in outpatient therapy myself for anxiety on several occasions.  My point is that it seems that a significant portion of the client's lives were spent thinking negatively about themselves, other people, or the expectations of the future.  As I have written about before, I believe strongly that our thoughts control, for the most part, our emotions and negative thinking inevitably leads to negative emotions.  Part of my initial interview with a client is to give them a homework assignment to thoughtfully make a list of their 8 best moments and their 8 worst moments.  I ask them to write a paragraph about each moment with details of what happened to make it so memorable.  I ask that they include their thoughts, emotions, sensory experiences (ie. images, sounds, smells) and all the important details that come to mind. 

In our next meeting I may ask them to go over the worst moments in some detail.  I should add that going over the worst moments may be too painful for some clients with severe anxiety disorders and so I sometimes delay this topic with them until a few sessions later.  Doing this exercise allows the client to quickly communicate to me the nature of the events that have shaped their manner of thinking and often it is immediately evident that they have a negative thinking pattern because of the traumatic or painful events of their past.  This is particularly evident for those clients who have abusive childhoods and early on in life begin to believe that they are in some way flawed, inadequate, unlovable or undeserving of success.  As we discuss the worst moments list I can observe their emotional experience and tell pretty quickly if they have "worked through" the emotional material or if they are still "stuck" in thinking about it.  If they are tearfully talking about it then I know we need to address it sometime in the therapy process.

During the second meeting I make a point to discuss their best moments list and spend a greater amount of time focusing on their positive experiences in their lives.  It is amazing how a person with anxiety seems to forget that they have been a success at anything in life.  Severely anxious clients seem to have dismissed any moments in their past which involved personal success in goals that they accomplished (and often only fleetingly enjoyed) or in the moments of their past when they felt a deep peace or sense of well-being.

Before I end the second session I will ask them if they would like to learn a simple technique that will give them immediate relief from anxiety.  Stupid question right?  They came for exactly that purpose, but it is important to give the client a sense of control so I never try something new in therapy without asking permission.  So we begin Strategic Self-Hypnosis training by having them place one hand on their stomach and the other on their chest.  I ask them to breathe deeply moving the hand on their stomach so they begin to do yogic or abdominal breathing for 12 breaths. While they are deeply breathing I ask them to just notice the movement of air into their nose, sinuses, chest and lungs.  As they focus on the movement of air I ask them to notice whether they are beginning to feel warmer, lighter, heavier, or just sleepy.  My suggesting that they will feel one of these four sensations is the hypnotic suggestion that they will then do outside of the therapy sessions on their own.

Clients will almost always smile during this exercise and note that they are feeling more comfortable in just a few breaths.  I then ask them to use their imagination to visualize a door of any size, shape, design, or texture that they like and to see on the door the words "Best Moments".  As they are becoming accustomed to visualizing the door I then ask them to imagine opening the door on one of their best moments and feeling themselves back in that situation that they are remembering.  I ask them to continue to deep breathe and to stay with the image deepening and making it more vivid with each breathe.  After perhaps five minutes I ask them to open their eyes and to right down what they experienced.  In the majority of cases, the clients reported a substantial reduction in anxiety and muscle tension in the very first trail of Strategic Self-Hypnosis.  This simple experience has been the first step for many of my clients in developing their own custom set of coping skills that they employ on a daily basis to overcome anxiety by simply changing the way they are breathing and the content of what they are thinking about.  You may want to try this at home, not while driving of course, and see what kind of results you have in changing your emotions and the sensations of your body.